Primary closure of mammalian bites

Objective: Suturing of bite wounds remains controversial. The authors evaluated the incidence of wound infection in 145 mammalian bite wounds treated with primary closure. Methods: Consecutive patients with bite wounds receiving primary closure at a university hospital ED had structured closed-question data sheets completed at the time of wound management and suture removal. Infection was determined at the time of suture removal using a previously validated definition. Data included demographics medical history time from injury to evaluation wound characteristics and location details of wound cleansing methods, debridement, foreign body removal, and wound closure methods use of antibiotics and follow-up wound evaluation. Proportions and 95% confidence intervals were calculated. Results: One hundred forty-five mammalian bite patients were enrolled: 88 dog, 45 cat, and 12 human bites. Patients had a mean (+/-SD) age of 21 +/- 20 years; 58% were male; 86% were white; and they presented a mean (+/-SD) of 1.8 +/- 1.2 hours after injury. Bites occurred on the head and neck (57%), upper extremity (36%), and lower extremity (6%). Wounds had a mean length and width of 2.5 cm and 4.8 mm, respectively. Twelve percent involved structures deep to subcutaneous tissue. After primary wound closure, wound infections occurred in eight patients (5.5%; 95% confidence interval = 1.8% to 9.2%). Conclusions: The data suggest that carefully selected mammalian bite wounds can be sutured with approximately a 6% rate of infection. This infection rate may be acceptable in lacerations where cosmesis is a primary concern.